To Catch that Cough!

In the times of the COVID 19 pandemic sweeping across the globe, there are so many conflicting messages out there , for people to digest, some talk of prevention (which is the only way to safety at present), some talk of prophylaxis (which is only for high risk individuals i.e those healthcare workers who are caring for sick patients, and close household contact of confirmed cases), some talk of treatments and vaccination (which are in various stages of trials, and are not likely to be anywhere on the horizon till early 2021 maybe).

For this post, I choose to discuss with you , my discerning reader, on the vexatious issue of catching that cough or sneeze, that moment in time when you take a deep , often ragged breath and go “ah-chooo” or whatever, in your language of preference.

Now, the current guidance being given by the leading public health agencies across the world, is something that every parent teaches their child… Cover your mouth when you cough! But then we all already know that, or do we? What about the vast majority of people who do not know, or have never been told that they should cover their mouth when coughing or sneezing?

Cover your mouth when you cough! Makes sense right?

You dont want someone else to breathe in those droplets right? That is what airborne transmission means.

If those droplets are given the chance, they gradually settle down and contaminate surfaces, such as table tops, door handles, chair arm rests, the floor etc. A healthy person acquires infection from these by touching these contaminated surfaces with his hands and then touching his own face (nose, mouth, eyes). And this is Indirect Transmission.

Now, what are the choices you have, to cover your mouth when you are coughing or sneezing?

1. With the palm of your hand? Well, think of those droplets you have intercepted, thereby contaminating your own hands, which if unwashed immediately afterwards, with soap and water, or usage of an alcohol based sanitizer, will contaminate other surfaces, or transmit to others through hand shakes and the like.
2. With tissues? Well , these need to be disposed off carefully afterwards, and not carried around or thrown around indiscriminately. How many people in India keep tissues with them?
3. With the back of your hand? Well , usually the back of your hand does not come in contact with any one or any surface usually (unless of course you are giving someone a backhanded slap instead of a backhanded compliment). In this situation too, you would need to wash your hands with soap and water.
4. With the crook of your elbow? Let me explain this in a bit more of detail….First, think of a woman in a long sleeved garment (kameez) or a man with a full sleeved garment…. or a child similarly…. Now this person coughs or sneezes into his or her elbow…which is cloth covered…. All the sticky , gooey droplets (micro-organism laden) spray goes onto the cloth at the elbow. And remains there till the time that garment is washed, with other garments… 99.9% times not with hypochlorite solution, nor with a 60 degrees wash cycle (this is India)….

Next, think of a woman or a man with a half sleeved garment…. or a child similarly…. Now this person coughs or sneezes into his or her elbow…which is bare skin…. All the sticky , gooey droplets (micro-organism laden) spray goes onto the skin of the crook of the elbow. And remains there only till the time that person has a bath and remembers to wash the elbow. (again…this is India)….

And also , you yourself just think… when was the last time you washed just your elbow fold??

Now, please answer the following
1. Will the long sleeved clothing possibly get contaminated by infective sneeze droplets… and remain so…?
2. Will this potentially infected cloth contaminate other clothes at home?
3. Will the laundry / washing in rural India ever be adequate enough to ‘disinfect’ such clothes? i.e hot wash and bleach pre soaks?
4. How often will a person actually end up washing his crook of elbow?
5. Is it not easier to cover with back of palm and then wash that afterwards? And this is slightly better than covering with the palm of your hand?

Covering of mouth and nose is what is important!!

That is what is the bottom line.

“The how” is just an exercise in changing behaviours… All of us who are not teenagers today, were taught socially to cover our mouths when we coughed, with our palms… Now we talk of crook of the elbow, why not also the back of the hand, i.e when we dont have access to tissues. There was an old English adage, “the rich keep their colds in their pockets while the poor blow it out onto the road” this of course was in reference to the usage of handkerchiefs by the ‘elite’.

Please let me know your views on the above… it will be interesting to discuss this further.

We all would agree unanimously I am sure, that the cough does need to be covered… My query to you is… what is advisable to be communicated through a population focused messaging campaign?